Fall risk higher with SSRIs

Depressed nursing home residents with dementia are three times more likely to have serious falls if they take certain medications, a new study reveals. The study author calls for consideration of new treatment protocols.

Residents who were on a class of antidepressants known as serotonin reuptake inhibitors (SSRIs) had a greater risk of falling as the dose of the medication rose, said lead author Carolyn Shanty Sterke, Section of Geriatric Medicine at Erasmus University Medical Center in the Netherlands.

Sterke looked at 248 nursing home residents with dementia over two years. Incident records showed 152 of the residents had a total of 683 falls. While the risk for an 80-year-old woman not taking SSRIs was .09%, it was .28% if she was taking the medication.

The drug use data came from a prescription database, and the data on falls and subsequent injuries came from standard incident records.

The results showed that:

Altogether, the data covered a total of 85,074 person-days, with records showing that antidepressants had been given on 13,729 (16.1%) days, and SSRIs dispensed on 11,105 of them.

The incident records showed that of the 248 participants, 152 (61.5%) sustained a total of 683 falls.

This corresponds to a fall rate of 2.9 per person per year.

38 residents had a single fall in the two-year period, but 114 fell frequently.

220 falls resulted in injury or, in the case of one resident, death.

10 of the falls resulted in hip fractures, 11 in other fractures, and 198 incurred grazes, open wounds, sprains, swellings and bruising.

There was a "significant dose-response relationship between injurious falls and the use of SSRIs".

The risk of an injurious fall "increased significantly with 31% at 0.25 of the Defined Daily Dose (DDD) of a SSRI, 73% at 0.50 DDD, and 198% [ie threefold] at 1.00 DDD."

The absolute daily risk for an 80-year-old woman not taking SSRIs was 0.09%.

For an 80-year-old woman taking one defined daily dose of SSRIs, it was 0.28%.

There were similar increases in absolute daily risks for both men and women at different ages.

The authors conclude:

"Even at low doses, SSRIs are associated with increased risk of an injurious fall in nursing home residents with dementia."

The risk increased even more if the residents were given hypnotic or sedative drugs, Sterke added, cautioning physicians to consider the fall risk when prescribing SSRIs. “I think we should consider developing new treatment protocols that take into account the increased risk of falling that occurs when you give people SSRIs," she said.

The study was published in the British Journal of Clinical Pharmacology: